Pey YVDepartment of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca St, Suite 6200, Baltimore, MD 21201

Abstract

Extracorporeal shock wave lithotripsy is a well-established treatment modality for renal calculi since the 1980s (Urology 1984;23(5):59–66). In general, it is a safe and effective noninvasive therapeutic modality for treatment of urolithiasis. Bleeding complications of this procedure are rare and usually involve the kidneys. In this case report, a 56-year-old woman developed severe abdominal pain with signs of hemorrhagic shock 2 days post–extracorporeal shock wave lithotripsy procedure. Computed tomography of the abdomen and pelvis showed a large intrahepatic hemorrhage that required hepatic artery embolization.

Comments
1

Hepatic hematoma is an extremely rare complication of SWL and only described in few cases. According to the CT-image the bleeding also obviously was localized at considerable distance from the stone-focus in the kidney and the question is if the shock wave did hit some vulnerable part of the liver or during some part of the treatment had a different focus?

Although nothing is mentioned about the energy settings of the lithotripter one can speculate that the hepatitis C has made the liver tissue/vessels more vulnerable to traumatic power. Similar to the case for renal hematoma, this type of complication should be early suspected when patients report pain that appears more pronounced than normal. None of these two kinds of bleedings can easily be predicted, if hypertension, cardiovascular disease, coagulation disorders and anticoagulation treatment have been excluded.

Hepatic hematoma is an extremely rare complication of SWL and only described in few cases. According to the CT-image the bleeding also obviously was localized at considerable distance from the stone-focus in the kidney and the question is if the shock wave did hit some vulnerable part of the liver or during some part of the treatment had a different focus?
Although nothing is mentioned about the energy settings of the lithotripter one can speculate that the hepatitis C has made the liver tissue/vessels more vulnerable to traumatic power. Similar to the case for renal hematoma, this type of complication should be early suspected when patients report pain that appears more pronounced than normal. None of these two kinds of bleedings can easily be predicted, if hypertension, cardiovascular disease, coagulation disorders and anticoagulation treatment have been excluded.
Hans-Göran Tiselius